Seizures may impact stroke thrombolysis outcomes
MedWire News: Anticonvulsant medication could improve outcomes after thrombolysis in patients with acute stroke, say researchers who found an association between seizures and poor outcome.
However, given the observational nature of the study "a causal association between early seizures and unfavorable outcome remains a hypothesis," caution Gerhard Schroth (University Hospital Bern, Switzerland) and co-workers.
Seizures affected around one in 20 of the 805 stroke patients in the team's study, all of whom underwent thrombolysis. Late seizures (>24 hours after stroke onset) occurred in 18 patients, and these patients had similar outcomes to those who remained seizure-free.
The other 26 patients had seizures within 24 hours of stroke onset. Half of these patients died within 3 months of stroke, compared with 22.3% of the seizure-free patients. Of the survivors, just 15.4% had favorable functional outcomes (modified Rankin Scale 0-2), compared with 46.8%.
Patients with early seizures were younger than seizure-free patients, at 57 versus 64 years, and had more severe strokes, with National Institutes of Health Stroke Scale scores of 19 versus 15. On multivariate analysis, asymptomatic intracranial hemorrhage was also associated with seizures.
However, early seizures remained associated with poor outcomes even after accounting for these and other variables. Early seizures conferred a 4.7-fold increase in the risk for an unfavorable outcome and a 5.9-fold increase in mortality risk.
Other predictors of poor outcomes included older age, severe stroke, symptomatic intracerebral hemorrhage, and poor recanalization.
"Our findings of a deleterious effect of early seizures raise the question whether immediate anticonvulsant therapy after early seizures or even prophylactic antiseizure therapy could improve outcome and reduce mortality," Schroth et al write in Stroke.
"It indicates the need for further research to identify patients with stroke at risk for early seizures and to search for effective prophylaxis and treatment."
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By Eleanor McDermid